불안정성 대퇴 전자간부 골절에서 측면 방사선 사진을 이용한 술 후 안정성에 대한 방사선적 접근 (Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph)

서지정보

· 발행기관 : 대한골절학회
· 수록지 정보 : Journal of Musculoskeletal Trauma / 29권 / 3호 / 171 ~ 177페이지
· 저자명 : 권석현, 박진영, 국승환, 유병민

초록

Purpose: The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs.Materials and Methods: Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochan-teric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displace-ment of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray.Results: Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9±3.2 mm, 4.6±3.6 mm, and 8.5±4.9 mm, respectively, and group 3 showed a significant result (p＜0.0001, p=0.024).Conclusion: In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appro-priate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.

영어초록

Purpose: The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs.Materials and Methods: Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochan-teric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displace-ment of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray.Results: Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9±3.2 mm, 4.6±3.6 mm, and 8.5±4.9 mm, respectively, and group 3 showed a significant result (p＜0.0001, p=0.024).Conclusion: In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appro-priate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.

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